Technology EvaluationCenter (TEC)

Service Through Research

Since 1985, Blue Cross and Blue Shield Association's Technology Evaluation Center, now the Center for Clinical Effectiveness (CCE), has been recognized for its leadership in evidence-based healthcare technology assessment. CCE provides healthcare decision makers with timely, objective, and scientifically rigorous assessments that synthesize the available evidence on the diagnosis, treatment, management, and prevention of disease.

Our assessments will help customers:

to understand the scientific basis for the effectiveness of different treatments and tests; and

make informed healthcare decisions.

What is the Center for Clinical Effectiveness?

Founded originally by the Blue Cross and Blue Shield Association (BCBSA) as the Technology Evaluation Center (TEC), now the Center for Clinical Effectiveness (CCE), pioneered the development of scientific criteria for assessing medical technologies through comprehensive analysis of clinical evidence. CCE operates as part of BCBSA's Office of Clinical Affairs.

Specialty Pharmacy Reports

TEC Assessment

Since its inception, CCE has been recognized for leadership in producing evidence-based technology assessments. Each TEC Assessment is a comprehensive evaluation of the clinical effectiveness and appropriateness of a given medical procedure, device, or drug. These reports provide healthcare decision makers with timely, rigorous, and credible information on clinical effectiveness. CCE’s TEC Assessments serve a wide range of customers in both the private and the public sectors, including Kaiser Permanente and the Centers for Medicare and Medicaid Services.

TEC Assessments are scientific opinions, provided solely for informational purposes. TEC Assessments should not be construed to suggest that BCBSA, Kaiser Permanente Medical Care Program, and CCE recommend, advocate, require, encourage, or discourage any particular treatment, procedure, or service; any particular course of treatment, procedure, or service; or the payment or nonpayment of the technology or technologies evaluated.

Staff

CCE is headed by Executive Director, Suzanne Belinson, Ph.D., M.P.H, Its core staff of research scientists consists of experienced physicians and doctorate-level scientists with a history of academic and primary research affiliations. These scientists are supported by professionals in pharmacology, nursing, statistical methods, and library science, and represent a multitude of clinical and methodological disciplines that are integral to performing technology assessments.

CCE’s Medical Advisory Panel, comprised of independent, nationally recognized experts in technology assessment, clinical research, and medical specialties, has scientific accountability for all TEC Assessments. The multidisciplinary member panel meets quarterly to review the quality of evidence and the relative weights of the potential patient benefits and harms of healthcare technologies. The Panel includes appointees from the American College of Physicians, American College of Medical Genetics, American Academy of Family Physicians, American College of Cardiology, American College of Surgeons, and consumer representation. Panel members who are specialty society appointees render independent judgments on issues presented to MAP; the results of TEC Assessments and Special Reports should not be construed to be either endorsed or approved by the individual appointing specialty societies.

Following each MAP meeting, CCE publishes the preliminary executive summaries of the reviewed Assessments as TEC Assessments In Press.

Kaiser Collaboration

CCE’s collaborative relationship with Kaiser Permanente began in 1993. As a result of collaboration, David M. Eddy, M.D., Ph.D., then Senior Advisor for Health Policy and Management, Kaiser Permanente’s Care Management Institute, served for over 10 years as a CCE's Scientific Advisor, until his stepped down in 2004. Currently, Kaiser Permanente’s Jo Carol Hiatt, M.D., is a voting member of CCE's Medical Advisory Panel. Dr. Hiatt is the Chair of the Interregional New Technologies Committee and the Chair of the National Product Council from The Permanente Federation.

What is Evidence-Based Medicine?

Evidence-based medicine is commonly defined as “The conscientious, explicit, and judicious use of current evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM, ed 2. London: Churchill Livingston, 2000.)

This information also allows patients to participate in the medical decision-making process with their physicians. By sharing in the decision making, patients can express their personal preferences and goals that underline how they would like their treatment handled.

AHRQ Evidence-Based Practice Center

In 1997, CCE, then the Technology Evaluation Center (TEC), was designated as one of 12 original Evidence-based Practice Centers (EPCs) for the Agency for Healthcare Research and Quality (AHRQ). Since then TEC and now CCE have continued to serve as an EPC. EPC reports provide the foundation on which organizations - such as physician specialty societies - develop clinical practice guidelines, as well as tools and strategies for improving the quality of healthcare services.

Technology Evaluation Center Assessments

The Center for Clinical Effectiveness (CCE) produces nationally respected evidence-based assessments of medical technologies. CCE publishes 15+ assessments and special reports annually. Each assessment comprehensively evaluates the clinical effectiveness and appropriateness of a given medical technology. These assessments are written by CCE's core staff. CCE is composed of experienced physicians and doctorate-level scientists, with a history of academic and primary research affiliations, and is guided by its Medical Advisory Panel (MAP). MAP is composed of nationally respected physician experts who have final scientific and clinical authority for all TEC Assessments.

Formulation of TEC Assessments is based on five criteria used to assess whether a technology improves health outcomes such as length of life, quality of life, and functional ability. Assessments also employ a formal approach in reviewing evidence.

Technology Evaluation Center Criteria

The Blue Cross and Blue Shield Association uses the five criteria below to assess whether a technology improves health outcomes such as length of life, quality of life and functional ability.

1. The technology must have final approval from the appropriate governmental regulatory bodies.

This criterion applies to drugs, biological products, devices and any other product or procedure that must have final approval to market from the U.S. Food and Drug Administration or any other federal governmental body with authority to regulate the technology.

Any approval that is granted as an interim step in the U.S. Food and Drug Administration's or any other federal governmental body's regulatory process is not sufficient.

The indications for which the technology is approved need not be the same as those which Blue Cross and Blue Shield Association's Center for Clinical Effectiveness is evaluating.

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.

The evidence should consist of well-designed and well-conducted investigations published in peer-reviewed journals. The quality of the body of studies and the consistency of the results are considered in evaluating the evidence.

The evidence should demonstrate that the technology can measure or alter the physiological changes related to a disease, injury, illness, or condition. In addition, there should be evidence or a convincing argument based on established medical facts that such measurement or alteration affects health outcomes.

Opinions and evaluations by national medical associations, consensus panels, or other technology evaluation bodies are evaluated according to the scientific quality of the supporting evidence and rationale.

3. The technology must improve the net health outcome.

The technology's beneficial effects on health outcomes should outweigh any harmful effects on health outcomes.

4. The technology must be as beneficial as any established alternatives.

The technology should improve the net health outcome as much as, or more than, established alternatives.

5. The improvement must be attainable outside the investigational settings.

When used under the usual conditions of medical practice, the technology should be reasonably expected to satisfy criteria 3 and 4.

Medical Advisory Panel

The Center for Clinical Effectiveness is guided by the Medical Advisory Panel (MAP), which is composed of nationally respected physician experts. MAP has final scientific and clinical authority for all assessments. Chaired by the Senior Vice President, Office of Clinical Affairs, Blue Cross Blue Shield Association, MAP comprises experts in technology assessment, clinical research methodology and implementation, and clinical practice. MAP membership is diversified to ensure representation by a wide variety of viewpoints within the healthcare community, including patients. Most members hold academic appointments and are independent medical experts without affiliation to healthcare payers.